Childhood Trauma And ADHD : Is PTSD Being Misdiagnosed As ADHD?

In the USA, about one in every nine children are diagnosed with ADHD; this equates to a total of 6.4 million American youths.

But should many of these young peoples’ primary diagnosis really be one of PTSD, not ADHD?

Many experts think so. In fact, Post Traumatic Stress Disorder (PTSD) may be being misdiagnosed as Attention Deficit and Hyperactivity Disorder (ADHD) in up to a million children per year in the USA.

The psychologist, Brown, an expert in the field, has drawn attention to the fact that many children who have been diagnosed with ADHD have symptoms which one would expect to find in people suffering from PTSD such as : difficulty controlling behaviour/impulsivity, severe mood fluctuations, hyper vigilance and dissociation ( or ‘zoning out’. – click here to read my article about dissociation).

The confusion may arise when such symptoms are mistaken for those of ADHD. For example:

– difficulty controlling behaviour/mood fluctuations may be seen as wilful disruptiveness

– hyper vigilance may be seen as distractability

– dissociation may be seen as deliberate inattention/lack of focus (indeed, I suffered from this when I was eight. I didn’t respond to my name in class, so lost and caught up was I in my own internal distressed thoughts, leading to my teachers actually suspecting that I was going deaf. I was taken for an ear test but there was nothing whatsoever wrong with my hearing – let this serve as a salutary lesson to teachers as to how a child’s distress may manifest itself in unexpected ways and be completely misinterpreted).

Brown’s suspicions that, often, children diagnosed with ADHD should, in fact, have been diagnosed with PTSD were heightened further by the observation that standard ADHD treatment simply did not work for many children.

Perhaps, then, Brown hypothesised, these children were, in facf, ‘acting out’ (what psychologists refer to as ‘externalizing’) their distress caused by living in a dysfunctional family (the children in the study came from low income families and were known to live in environments in which high levels of stress and violence were prevalent).

In order to examine the issue further, Brown set up a study looking at the overlap between the symptoms of ADHD and the effects of traumatic stress on children caused by maltreatment and abuse.

A Closer Look At The Link Between Childhood Trauma And ADHD :

The study was based on a survey of 65,000 children in the USA and the results showed that those who had been diagnosed with ADHD also had a significantly higher than average chance of coming from a background of divorce, poverty, violence and/or families who misused drugs and alcohol.

Indeed, those who had experienced the great stress of 4 or more ADVERSE CHILDHOOD EXPERIENCES (ACEs) – click here for more information about these – were 3 times more likely to have been diagnosed with ADHD and prescribed medication for it than those who had not experienced any.

The psychologist, Szymanski, derived similar results from a study of 63 children who had been treated by a psychiatric hospital. On average, the children had suffered 3 ACEs yet only 8 per cent had been diagnosed with PTSD whilst 33 per cent had been diagnosed with ADHD.

Conclusions:

The above studies suggest that there is a link between childhood trauma and ADHD and that many children could be being mistakenly diagnosed with ADHD whereas, in fact, their primary diagnosis ought to be one of PTSD. Some estimates suggest that up to one million children per year could be being misdiagnosed in this way.

Implications for treatment:

If children are being treated for ADHD when they should, in fact, be being treated for PTSD, their treatment may be inappropriate.

Indeed, one treatment for ADHD is the prescription of stimulants. However, this could worsen symptoms of agitation (agitation is a symptom of PTSD). NB Any changes in medication should only be made on the advice of a properly qualified professional who is familiar with the specific case under consideration.

Furthermore, treatment for ADHD does not deal sufficiently with the emotional and psychological distress that the child with PTSD suffers.

Why might misdiagnoses be happening?

One reason that has been suggested is that the companies producing the drugs for ADHD use advertising campaigns which, in effect, encourage the diagnosis of ADHD and its treatment, thus increasing their profits.

A second suggestion is that the assessment of children by clinicians is not extensive or thorough enough due to time and financial restrictions. A fifteen minute or half hour appointment is not enough to evaluate, fully, a child’s mental state and factors related to his/her home life which may be damaging it.